The proliferation of care outside of an inpatient setting has presented many challenges to New York state health regulators. Do patients know the difference between a retail clinic and a medical home? Should care be regulated according to where it is delivered?

For the past year, members of the Public Health and Health Planning Council, advised by ambulatory care providers, have pondered such policy questions. Their efforts have been consolidated into a draft of proposals, online here, that will be reviewed at this week's meeting.

"New models of ambulatory care delivering specialty services have complicated relationships between hospitals and physicians over the past two decades," reads the report. Hospitals feel that the new models take away revenue from hospitals by drawing away commercially insured patients, while doctors say they are providing lower-cost care in a more efficient setting.

The PHHPC considered extending the certificate-of-need process to physician practices, or requiring practices to meet Article 28 standards, for example. It judged oversight of ambulatory care from the perspective of competition, standardizing names and signage for types of sites, clinical standards, and continuity of care with primary care doctors.

The draft of recommendations suggest that retail clinics need better labeling of their limited services, should not treat babies under 24 months, should not vaccinate children other than with flu shots, and should be open 12 hours on weekdays and eight on weekends.

The council found that "urgent care" signs are confusing to patients. Some are run by hospitals while others are run by group practices. It recommended standardization and some changes in licensure and accreditation.

The council recommends banning nonhospital-owned freestanding emergency departments and other actions to eliminate the "unwanted proliferations of FEDs seen in other states."